The contribution of (1)H-magnetic resonance spectroscopy in defining the pathophysiology of multiple sclerosis

Proton magnetic resonance spectroscopy ('HMRS) is considered a suitable investigation technique for obtaining in vivo information on pathological changes in multiple sclerosis (MS) brain. The main metabolites identified are choline-containing compounds, creatine, yV-acetylaspartate (NAA), lactate, mobile lipids, myo-'mostiol, glutamate and glutamine. Proton spectra may be acquired from localized volumes of interest on single MS lesions or from the entire brain by 'H-MRS imaging. An increase of choline and lipids (markers of demyelination) and the presence of lactate (marker of acute inflammatory reaction) have been demonstrated in active Gd-enhancing MS plaques. A reduction of NAA (marker of neuronal or axonal damage) has been found in inactive MS lesions. The recent evidence of an early NAA decrease in active plaques and in normal appearing white matter suggests that axonal damage is an early event in the evolution of demyelinating lesions. The correlation between NAA decrease and clinical disability confirms that axonal damage has important functional consequences, and indicates that the prevention of irreversible axonal loss might be a major target for the design and the timing of therapeutical strategie